Cancer pioneer rises from Hiroshima's rubble

Out of Hiroshima, a cancer pioneerFor Houston's Dr. Komaki, living strong means seeking cures with force that also kills

Published 5:30 am, Saturday, August 6, 2005

Dr. Ritsuko Komaki was a baby when the United States dropped the atomic bomb on Hiroshima, but the memories still sear her brain.

There was her aunt, 19 on that fateful day, who never got over the harrowing images she witnessed: severely burned people dying all around her, some after jumping into the river to escape the heat. She died of a tranquilizer overdose years later.

There was her grandmother, who survived the bombing that destroyed her house and killed six of her grown children but who suffered every side effect of total body irradiation — including nose bleeds, diarrhea, her hair falling out.

There were her orphaned or dying schoolmates, one of whom — her best friend, Sadako Sasaki — became a legendary figure, an international symbol of war's young victims. Sadako died at age 12 of leukemia, "the atom bomb disease."

"It was all very sad," Komaki says. "I tried to be positive, but there weren't many happy stories. It was a bad time."

Sixty years after the bomb ravaged Hiroshima, the times are immeasurably better for Komaki, though radiation remains her life's dominant force. A radiation oncologist at the University of Texas M.D. Anderson Cancer Center, she harnesses the same radioactive energy that claimed the lives of loved ones to save lives of people afflicted with cancer.

It is an irony often pondered by Komaki, 61, who calls radiation "a double-edged sword that can kill or cure depending on the volume or dosage used." She jokes that it is perfectly in keeping with the Zen calendar in her office.

Komaki talks excitedly about the next big advance in the therapeutic edge of radiation's sword — treatment that, by substituting proton radiation for the X-rays now used to treat many cancers, delivers lethal damage to malignant growths without harming surrounding tissue. A facility the size of a football field that will employ the cutting-edge therapy is set to open at M.D. Anderson early next year. It will be the third such center in the United States and easily the most sophisticated.

Is Hiroshima remembered?

But for all the therapeutic good to come of radiation, Komaki remains concerned about the cataclysmic potential of nuclear weaponry, weaponry that on Aug. 6, 1945 instantly took thousands of Japanese lives and by year's end had claimed roughly 140,000 of Hiroshima's estimated 350,000 people. Even more people succumbed to cancer and other radiation-related ailments in the years after.

"After so much time you wonder if people still remember what happened in Hiroshima," Komaki says. "I don't think the younger generation has any concept of what it was like to live under that cloud."

Komaki's remembers all too well. Her earliest memories are not idyllic ones playing with dolls, she says, but hunger, the result of the city's devastation. Memories from later in her childhood involve death.

Komaki's family came from Hiroshima, but when the bomb dropped, her parents were living near Osaka, about 200 miles away. The next day, her father went to Hiroshima, where he was exposed to the radioactive "black rain," while searching for his mother and siblings. He died, decades later, of bladder cancer.

Her parents moved back to Hiroshima when Komaki was 4 — something many people were doing at the time out of fear their abandoned property would be taken by others, so precious is available land in Japan. By then, for example, the site of Komaki's grandmother's house had been claimed by someone else, so the family was forced into smaller quarters further from the city's center.

In elementary school, Komaki became best friends with Sadako, an energetic, athletic girl seemingly unharmed by the bomb that exploded a mile from her house when she was 2. She and Komaki competed in races until one day the 11-year-old Sadako became dizzy and fell to the ground while running, the first sign of her leukemia.

Buried with 1,000 birds

Told of a Japanese legend that anyone who folds 1,000 paper cranes (symbol of peace and longevity) would be cured of their disease, Sadako set out to make the origami craftwork, often using the wax paper wrapping her medicine. When she died before completing the task, schoolmates finished the job so she could be buried with all 1,000 birds.

But the schoolmates didn't stop there. Led by Komaki, they raised $100,000 to build a monument to Sadako at Hiroshima Peace Memorial Park, a bronze statue of a young girl standing atop a bomb and holding a huge golden crane. Unveiled in 1958, it fast became a landmark — a cry by innocent children for peace — and still draws thousands of young students bringing brightly colored paper cranes every sixth of August.

"Because it came from the children, it touched adults," Komaki says. "They were so focused on their daily lives and suppressed from saying anything about World War II, which is the Japanese way — avoid unpleasant subjects. The statue marked one of the first times the bomb was openly discussed."

Sadako's death was an influential event in Komaki's life. Along with the deaths of some family members, it motivated her to become a doctor, though her original plan, predictably, was to become a hematologist, a specialist in diseases of the blood, including leukemia.

She became a convert to radiation in the United States, where she finished her training when medical students went on strike in Japan. At a time when chemotherapy was cruder than it is now, she saw patients with very early stage cancers — head and neck, cervix, Hodgkin's disease — cured by radiation. It changed her thinking.

During that time, she also met James Cox, now her husband and the director of M.D. Anderson's proton therapy center. Because of their relationship, she decided to stay in the United States

It wasn't a popular decision with her father, whose happiest memory wasn't the U.S. occupation after the war and who didn't like his daughter being taken away by a gaijin, an Occidental foreigner. He didn't talk to her for two years but finally softened after going out for a beer with Cox.

"I think he felt reassured after meeting me and seeing us together," Cox recalls. "He realized how much I loved his daughter, that I would take good care of her."

Together, Cox and Komaki pioneered new treatments for lung cancer using radiation — higher-dose, more-precise protocols such as three-dimensional conformal radiation therapy, a combination of chemotherapy and radiation used when the disease spreads to the lymph nodes.

Initially, much of what experts knew about the effects of radiation came from studies done in Hiroshima in the years after the bomb was dropped. Long-term study of the victims helped doctors understand not only what radiation does but also how its effects can be minimized.

Proton therapy's promise

But improving on that knowledge was a goal of Komaki's. She had noticed that many of those patients whose radiation treatment cured their early-stage cancers later developed significant side effects from the therapy. She wanted to stop that.

Nothing promises to minimize side effects better than proton therapy. It sends particles, much heavier than

X-rays, that travel in a straight path without being deflected. Unlike X-rays, the particles don't lose their velocity when they reach their target — dense tissue. Expected to be beneficial for everything from pediatric cancers to cancers of the eye, proton therapy is most effective when directed at single, well-defined tumors, especially ones close to sensitive nerves and organs, such as the lungs and prostate.

When it's fully functional, M.D. Anderson officials expect to use proton therapy on roughly 3,400 people a year, many drawn from around the country. They estimate it initially will be applicable in 30 percent of radiation-eligible patients.

"I think this therapy will raise the consciousness about radiation throughout the field," Cox says. "The consequence of wonderful advances over the last 12 years, it will mark the beginning of a profound change, a change in which doctors give powerful radiation therapy without causing damage to healthy tissue."

Japan moves forward

Proton therapy is already changing the landscape in Japan.

With several centers in operation, it marks a departure from the country's longstanding resistance to conventional radiation as cancer treatment, the sort of resistance that led a Japanese surgeon to tell one patient that chemotherapy followed by surgery was his only option and that he had six months to live. Treated with radiation by Cox and Komaki at M.D. Anderson instead, he's still alive seven years later.

Still, given Japan's history, Komaki understands the anxiety.

She herself still feels the fear of the bomb's power. She felt it on 9/11, during a recent academic trip to Korea and periodically as hostilities continue in Iraq and terrorism erupts in different spots around the world.

"I do have fears," Komaki says. "I wonder what it might be like if somebody decided to drop nuclear weapons — I'd like to tell the next generation it should never happen again. As someone who grew up in its shadow, I know the memories never go away."

Latest from the Chron.com Homepage

Click below for the top news from around the Houston area and beyond. Sign up for our newsletters to be the first to learn about breaking news and more. Go to 'Sign In' and 'Manage Profile' at the top of the page.